FIELD OFFICE USE ONLY

OCCUPATIONAL LICENSING NUMBER ISSUED

PHOTO SEQUENCE NUMBER

TOTAL FEE COLLECTED

DATE FEES PAID (DATE LINE STAMP)

APPLICATION FOR SALESPERSONS LICENSE
Temporary Permit Issued
ALL APPLICATION FEES ARE NON-REFUNDABLE Yes Date
No If no, attach temporary permit
Attach DMV 8016
HEADQUARTERS USE ONLY
DATE OCCUPATIONAL LICENSE EXPIRES
All licensees are responsible for renewing their license prior to the expiration date shown on license.

SECTION 1 — APPLYING FOR (Check one box.)

Original (SPO) Renewal (SPR) Reinstatement (SRX) (expired license)

SECTION 2 — APPLICANT INFORMATION (Type or Print) USE YOUR TRUE FULL NAME
NAME (FIRST, MIDDLE, LAST ) TELEPHONE NUMBER

( )
EMAIL ADDRESS

RESIDENCE ADDRESS (NUMBER AND STREET ) CITY STATE ZIP CODE

OTHER ADDRESS, IF APPLICABLE (P.O. BOX OR PRIVATE MAIL BOX ) CITY STATE ZIP CODE

DATE OF BIRTH SEX HAIR COLOR EYE COLOR HEIGHT WEIGHT

Male Female Nonbinary

CALIFORNIA DRIVER LICENSE/IDENTIFICATION CARD NUMBER EXPIR ATION DATE SOCIAL SECURITY NUMBER

Have you ever been known by or used any name other than the name appearing on this questionnaire?.................................... Yes No
IF YES, LIST NAME(S)

SECTION 3 — ADDITIONAL BACKGROUND INFORMATION

1. Have you previously been or are you now licensed or have you ever applied in this state as a vehicle salesperson, representative,
distributor, dealer, dismantler, manufacturer, remanufacturer, transporter, verifier, lessor‑retailer,driving school owner, operator,
instructor, traffic violator school owner, operator or instructor, or all‑terrain vehicle safety training organization or instructor?.... Yes No
IF YES, LIST LICENSE NUMBER

2. Have you ever had a business, occupational license, or application issued by the State of California, Department of Motor
Vehicles, or by another state, which was refused, revoked, suspended or subject to other disciplinary action? ......................... Yes No
IF YES, LIST TYPE OF LICENSE, LICENSE NUMBER, ACTION BY DEPARTMENT, DATE OF ACTION, AND STATE LICENSE WAS ISSUED

3. Have you ever had a civil judgment rendered against you, or as a sole owner, partner, managerial employee, public administrator,
officer, director, stockholder, or LLP/LLC managing member? ...................................................................................................... Yes No
If yes, was it a result of a state issued licensed activity? ............................................................................................................... Yes No
IF YES, STATE THE AMOUNT AND WHETHER PAID OR UNPAID

IF YES, DESCRIBE TYPE OF LICENSE, LIST LICENSE NUMBER, STATE LICENSE WAS ISSUED, NAME AND LOCATION OF COURT OF JURISDICTION

4. Have you as a sole owner, partner, managerial employee, officer, director, stockholder, or LLP/LLC managing member sought
relief from creditors due to financial hardship in either state or federal court? .............................................................................. Yes No
IF YES, DESCRIBE TYPE OF LICENSE, LIST LICENSE NUMBER, STATE LICENSE WAS ISSUED, GIVE DATE BANKRUPTCY FILED, NAME AND LOCATION OF COURT OF
JURISDICTION

5. Do you currently have any criminal charges pending against you in any jurisdiction? .................................................................. Yes No
IF YES, LIST THE STATE, COURT, CASE NUMBER, AND NATURE OF THE CHARGES

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 DMV USE ONLY
OCCUPATIONAL LICENSING NUMBER

6. EXCLUDING TRAFFIC OFFENSES: have you ever been CONVICTED, PLACED ON PROBATION, OR RELEASED
FROM INCARCERATION FOLLOWING CONVICTION for any crime or offense, either Felony or Misdemeanor, of ANY
jurisdiction, within the last ten years? ............................................................................................................................................. Yes No
If yes, read Important Notice To All Applicants below and complete Section 4.

IMPORTANT NOTICE TO ALL APPLICANTS

TO EXPEDITE A REVIEW OF YOUR APPLICATION, YOU MAY SUBMIT A COPY OF THE ARRESTING AGENCY REPORT AND A
CERTIFIED COPY OF THE COURT DOCUMENTS.
Even if you were pardoned, pled nolo contendere, or if the conviction was later expunged from the record of the court or set aside under
California Penal Code (CPC ) §1203.4, or any other federal or state law equivalent, you must disclose the conviction for licensing purposes. If
you are awaiting judgment and sentencing following entry of a plea or jury verdict, you must still disclose the conviction. Failure to disclose
all convictions, including those out‑of‑state or out‑of‑country may result in the cancellation of the temporary permit and may result in the refusal
of the occupational license. Listing all conviction information may not necessarily preclude you from receiving a license. Applicants need
NOT disclose a conviction for violation of California Health and Safety Code (CHSC) §§11357(b), (c), (d) and (e); or 11360(b), if the
conviction is more than two years old.
Applicant Initials Required
FAILURE TO INITIAL WILL DELAY PROCESSING OF THIS APPLICATION

SECTION 4 — MISDEMEANOR OR FELONY CONVICTIONS

DISPOSITION OF OFFENSE
CONVICTION CONVICTED COURT OF JURISDICTION (DESCRIBE SENTENCE)
DATE OF (FULL NAME AND ADDRESS) Amount Term of Jail or Date
Fined Probation Prison Term Released

(ATTACH SEPAR ATE SHEET IF ADDITIONAL SPACE IS NEEDED)

SECTION 5 — APPLICANT CERTIFICATION

I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
I further certify (or declare) under penalty of perjury under the laws of the State of California pursuant to CCR Title 13, Article 7, that
I am a citizen of the United States, or I am eligible to apply for this benefit under the requirements of the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996. (initial)
SIGNED DATE

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 IT IS IMPORTANT THAT YOU READ AND UNDERSTAND
THE FOLLOWING INFORMATION.
ADVISORY STATEMENT
The information required on the attached form pertains to eligibility for issuance of an occupational license. It is required under
authority of Division 5 of the California Vehicle Code (CVC). Failure to provide the information is cause for refusal to issue an
occupational license.
This information is public record, regularly used by law enforcement agencies, and is open to inspection by the public. Information
contained in these records, classified as confidential or personal pursuant to the Information Practices Act of 1977 and the Public
Records Act, is exempt from disclosure. Individuals are entitled to inspect or obtain copies of information contained in their records
during regular office hours by prior arrangement.
The Occupational Licensing Branch, P.O. Box 932342, Sacramento, CA 94232‑3420, is responsible for maintaining this information.

DISCLOSURE STATEMENT
SOCIAL SECURITY NUMBER COLLECTION DISCLOSURE — You are required by law to provide your social security
number or your application will be denied.
“Your social security number will be collected pursuant to California Business and Professions Code (CBPC) §30. It is used in the
administration of occupational licensing laws to determine eligibility for issuance or renewal of an occupational license subject
to the applicable provisions of the CVC, CBPC §§29.5, 30 and 31, as well as California Welfare and Institutions Code (CWIC)
§11350.6. It is also used to aid in the collection of monies owed in connection with failure to pay a fine or failure to appear in court
by an applicant; and to aid in the collection of monies owed by an applicant in connection with Aid to Families with Dependent
Children, Child Support and Establishment of paternity and Federal Payments for Foster Care and Adoption Assistance Programs,
pursuant to 42 U.S.C. §§405 and 42 U.S.C. §651 et seq.
Your social security number is not provided for public inspection; however, it will be provided in response to requests for information
from state and federal agencies operating and involved in the collection of taxes and child support payments pursuant to 42 U.S.C.
601 et seq., and CBPC §30.
Collection of your social security number is mandatory. Failure to furnish the information requested will result in denial of processing
an application for issuance or renewal of an occupational license or permit, pursuant to CBPC §30, subdivision(c).”

DELINQUENT TAX DEBT

DELINQUENT TAX DEBT (Effective July 1, 2012) — California state law allows the California Department of Tax and Fee
Administration and the Franchise Tax Board to share taxpayer information with the DMV and requires you to pay a delinquent
state tax obligation. Failure to pay this delinquent tax obligation may result in the suspension of your Salesperson license.

Please be advised that you may not reapply for a license until a period of one year has elapsed since a previous
license for which you are applying now has been revoked, refused, or denied pursuant to CVC §§11810(d) and
11107(c).

Applicant should retain this page for their information.

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